Annie,

Surprisingly, the role of IgG4 subclass antibodies has not been appreciated enough for many years, as they do not fix complement and do not lead to destruction. The understanding that antibodies can exert their effect by internalization and blocking of essential cellular pathways is relatively recent.

Even more so the understanding that this can lead to a much more severe (and not milder) course of the disease.

The mistake ER made with me was to send me home with Albuterol twice when my neck was weak, I could barely walk, and when I couldn't breathe. I tried the Albuterol and it didn't help. I don't have asthma. When my breathing issue is a problem it feels as though all the muscle in my upper chest are smashing my diaphragm. My upper back muscles are so weak they just hang at times and my upper arms feel like dead meat. The Mestinon is working for my breathing but not for other muscles. I just had an xray of the lumbar with a few vertebrae into my thoracic area because the weight of my upper body has caused problems with my spine. I can't lift anything or else all the air is expelled as if I was punched in the stomach and afterwards I can't stand straight without lifting my upper body with my arms. My ribs feel like a lot of pressure is placed on them too. Sometimes it's hard to even hold my head up. I think if I could find something else to help the Mestinon my muscles might relieve the pressure on my diaphragm and spine. If I take any more Mestinon then my swallowing is an issue. Maybe I'll try taking a half pill more and see if it helps.

I don't hear people on here talking much about upper body weakness (especially in the upper back). I not only have the upper body weakness my thighs feel like lead weights.